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Dose-volume relationship of acute and late small bowel toxicity from radiation therapy for prostate cancer: a Veterans Affairs study

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

The objective of this study was to characterize the dose-volume relationship of small bowel toxicity during prostate radiation therapy in a homogenous Veterans Affairs population using modern IMRT/VMAT radiation techniques.

Methods

All records of patients receiving radiation therapy for prostate cancer at the Veterans Affairs Long Beach Hospital between 2009 and 2011 were analyzed (n = 73). Peritoneal space contents were contoured on each slice of the planning CT scan. A median dose of 75.6 Gy was delivered with either intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). The small bowel constraint used was V45 < 200 cc. Median follow-up was 2.4 years. Toxicity was scored using CTCAE v4.0 to grade acute and late small bowel toxicity.

Results

Seventeen patients (23 %) experienced acute grade 1 small bowel toxicity. Twenty-seven patients (37 %) experienced acute grade 2 small bowel toxicity. There was 3 % grade 1 and 10 % grade 2 late small bowel toxicity. There was no grade 3 or higher acute or late bowel toxicity. The mean volume of a small bowel receiving a dose of 45 Gy was 58 cc, range (2–193 cc). Nineteen patients (26 %) received greater than 52 Gy, range (52–80 Gy) and had no late small bowel toxicity. Multivariate analysis showed that prior abdominal surgery predicted acute small bowel toxicity HR = 4.6 (95 % CI 1.24–20.5) p = 0.03.

Conclusion

In this Veterans Affairs population of prostate cancer patients treated with radiation, V45 < 200 cc minimizes small bowel toxicity. However, we show this constraint can possibly be exceeded without significant short- and long-term complications. Further studies should explore maximum tolerated dose-volume relationship to maximize tumor control without increasing the small bowel toxicity profile.

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Compliance with ethical standards

For this type of study, formal consent is not required. This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Radiation Oncology Long Beach Veterans Affairs Hospital, Long Beach, CA, USA

    Garrett Green, Juying Zhang & Samar Azawi

  2. Department of Radiation Oncology, University of California, Irvine Chao Comprehensive Cancer Center, Orange, CA, USA

    Garrett Green, Alexander J. Lin & Nilam Ramsinghani

  3. Department of Radiation Medicine and Applied Sciences, University of California, 3855 Health Sciences Drive, La Jolla, San Diego, CA, USA

    Garrett Green

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  1. Garrett Green
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  2. Alexander J. Lin
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  3. Juying Zhang
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Correspondence to Garrett Green.

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Green, G., Lin, A.J., Zhang, J. et al. Dose-volume relationship of acute and late small bowel toxicity from radiation therapy for prostate cancer: a Veterans Affairs study. J Radiat Oncol 4, 411–415 (2015). https://doi.org/10.1007/s13566-015-0205-8

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  • DOI: https://doi.org/10.1007/s13566-015-0205-8

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